ACA: Lowering Health Care Costs & Expanding Coverage

The "State of the ACA" Report

On the 12th anniversary of the Affordable Care Act (ACA), the U.S. Department of Health and Human Services (HHS) released a new report highlighting data on the 2022 Open Enrollment Period and key health care coverage gains made under the Biden-Harris Administration. The “State of the ACA” report, published by the Centers for Medicare & Medicaid Services (CMS), shows that the Affordable Care Act is at the strongest it has ever been because of President Biden’s robust investments through the American Rescue Plan (ARP):

  • A record-breaking 14.5 million TOTAL consumers signed up for health care coverage nationwide – a 21 percent increase from last year.
      • Nearly 6 million NEW consumers signed up for coverage through the Marketplaces– 2.8 million newly enrolled during the 2021 Special Enrollment Period (SEP) and 3 million newly enrolled during this year’s Open Enrollment Period (OEP).
  • 2.8 million more consumers are receiving tax credits in 2022 compared to 2021. These tax credits are helping families keep more money in their pockets for essentials as we recover from the COVID-19 pandemic.
      • Without the ARP, the average monthly premium after Advanced Premium Tax Credit (APTC) for enrollees would have been $59 per month higher, or 53 percent higher.
      • An estimated 3.4 million Americans currently insured in the individual market would lose coverage and become uninsured if the ARP’s premium tax credit provisions are not extended beyond 2022.
  • The uninsured rate fell from 10.3% for the last quarter of 2020 to 8.9% for the third quarter of 2021 (July – September 2021) after implementation of the ARP, the 2021 SEP, and expanded outreach efforts.

Strengthening the ACA

President Biden is committed to building on the progress made by the ACA by:

  1. Reducing premiums for the millions of Americans enrolled in Marketplace coverage
  2. Closing the Medicaid coverage gap, which would lead to four million uninsured people gaining coverage.
    • Over 18.7 million adults are now covered across 39 states (including the District of Columbia) due to Medicaid expansion, though 12 states have not expanded.  
  3. Announcing a new SEP opportunity for low-income people to easily enroll in Marketplace coverage throughout the year and benefit from the ARP savings.
    • People with household incomes under 150% of the Federal Poverty Level will be eligible for premium tax credits under the ACA and ARP, which is approximately $19,000 for an individual and $40,000 for a family of four in 2022.
    • 45% of consumers who signed up for health coverage using the platform during the 2021 SEP had household incomes under 150% of the Federal Poverty Level. 
  4. Calling for federal agencies to review whether administrative policies could improve the affordability of dependent coverage, hinting at a potential administrative fix to the “family glitch”.
    • An employee whose contribution for self-only coverage is less than 9.83% of household income is deemed to have an affordable offer, which means that the employee and his or her family members are ineligible for financial assistance on the Marketplace, even if the cost of adding dependents to the employer-sponsored plan would far exceed 9.83% of the family’s income. This definition of “affordable” employer coverage has come to be known as the “family glitch.
    • More than 5.1 million people fall into the ACA family glitch. 
    • A fix to the family glitch would:
        • Help Americans who are currently enrolled in employer-based coverage or individual market coverage pay lower premiums if they are allowed to buy subsidized Marketplace coverage.
        • Allow a small number of uninsured people to gain coverage.

From March 21 to March 25, HHS hosted a week-long celebration of the 12-year anniversary of the ACA, highlighting the impact of the law and the Biden-Harris Administration’s commitment to building on its success. The theme of the week-long celebration was: “ACA: 12 Years of Advancing Health Equity for All Americans.” Each day of the week, HHS spotlighted ways in which the ACA has made gains in addressing health disparities of women and families, kids, older adults, people with disabilities, LGBTQI+ and communities of color. See photos from the recent 12th ACA Anniversary commemoration HERE.


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